96 DISEASES OF THE URETHRA. 



the pain. After the inflammation has subsided somewhat, we should 

 proceed to the use of injections of tannin in these cases also. The 

 fact that their action is less certain in this stage of the disease is 

 probably because, when of long standing, the inflammation is no longer 

 confined to the more accessible anterior portions of the urethra, but 

 has spread into the posterior regions, where an injection can reach it 

 less easily. In tedious cases, in which injections of tannin are more 

 apt to fail, I have often made use of the other astringents above men- 

 tioned, without, however, obtaining any better success. When astrin- 

 gent injections remain without effect, it is time to have recourse to cu- 

 bebs and balsam of copaiba. There is no doubt but that these articles 

 are also efficacious in the earlier stages of the disease, and that many 

 a clap has been " aborted " by their use in free doses. If, however, we 

 can succeed without them, it is better to do so, rather than to subject 

 the stomach and intestine to the action of these noxious substances. 

 It not unfrequently happens that protracted gastric and intestinal 

 catarrhs result from the abuse of cubebs and balsam of copaiba. More- 

 over, the abortive action of these remedies, according to my experience, 

 is often merely temporary much oftener than is that of injections 

 so that patients, who have supposed themselves well of then* disease, 

 in a few days have as free a discharge again as they had before using 

 the medicine. The idea, that strictures are more liable to occur under 

 the use of injections than where gonorrhoea is treated by internal 

 medication, is based upon an error. It is true that formerly a great 

 many patients who were treated by injections had strictures after- 

 ward ; but the reason of this was, that injections were only resorted 

 to in very chronic cases of the disease, while cubebs and copaiba were 

 given in the more recent ones. 



The long duration of a gonorrhoea is the most frequent cause of 

 strictures. The early use of injections, and consequent speedy stoppage 

 of the blennorrhcea, is the best preventive of their occurrence ; just as 

 permanent thickening of the conjunctiva is best averted by the early 

 and active applications of astringents. Where cubebs and copaiba are 

 used, it should be in full doses, which, however, must not be kept up 

 too long ; that is, not longer than three or four days after the discharge 

 has ceased. Large doses are relatively better borne than is the long- 

 continued administration of smaller ones, while the latter do not ac- 

 complish the object better, even when kept up for weeks. Cubebs 

 alone can be taken very well, if finely powdered and stirred up in 

 soda-water. Four or five heaped teaspoonfuls of the powder may be 

 given in the day. Balsam of copaiba is best prescribed in gelatine 

 capsules, four, six, or eight of which may be taken daily. Should we 

 wish to combine the two articles, we recommend the pills of cubebs. 



